Optimizing a couples-based mHealth intervention for weight management

摘要 体重是已婚和同居夫妇的双重健康问题。合作伙伴往往会进入这个关键的 人际关系与相似的体重状况，随着时间的推移一起增加体重。尽管如此，共享 风险，标准的行为干预集中在个人，而不是夫妇，在很大程度上忽略了固有的二元 体重管理的本质。早期的夫妇减肥计划测试缺乏一个明确的概念 指导配偶/伴侣的参与和结果好坏参半。然而，有一些有希望的信号-理论上和 经验-指导如何利用夫妻关系来改善减肥效果。的 拟议的研究旨在建立在这项工作的基础上，并开发一种有效的基于夫妇的移动健康方法， 使用多阶段优化策略（MOST）框架的重量损失。在准备阶段，我们 我开发了一个概念模型，借鉴了交互目标动力学理论，我们自己的试点工作， 已发表的文献，包括四个二元干预组成部分：二元行动计划，联合反馈 关于目标进展、自主支持训练和家庭环境修改。拟议 在优化阶段，我们计划进行创新和有效的析因实验，以确定 四个二元干预组成部分的组合-当添加到标准的核心组成部分时 行为减肥计划（BWL;例如，每周的课程，自我监控，反馈）-结果最大 6个月时的体重减轻（主要结局）。为期6个月的干预将提供给已婚和 通过本地智能手机应用程序对同居夫妇（N=368对）进行干预，以提高干预的覆盖范围， 最大限度地减少负担，吸引人口和关系更加多样化的夫妇。评估将 发生在0、3和6个月。体重减轻和理论中介作为框架的交互目标动力学 理论（例如，目标协调）将被评估沿着与假设的主持人（关系和 人口变量）。最大限度地减轻体重的新型二元干预组件集将是 选择纳入优化的干预方案，以便在未来的随机对照研究中进行评价。 审判这项拟议中的研究是对已婚和同居者进行完全mHealth减肥干预的第一次测试 夫妻。使用MOST设计，它将通过隔离活动， 二元干预成分及其作用机制。

ABSTRACT Weight is a dyadic health issue in married and cohabitating couples. Partners tend to enter this critical interpersonal relationship with a similar weight status and gain weight together over time. Despite this shared risk, standard behavioral interventions focus on individuals, not couples, largely ignoring the inherently dyadic nature of weight management. Early tests of couples weight loss programs lacked a clear conceptualization guiding spouse/partner involvement and results were mixed. Yet there are promising signals – theoretical and empirical – to guide how couples’ relationships can be harnessed to improve weight loss outcomes. The proposed study aims to build on this work and develop an efficacious couples-based mHealth approach to weight loss using the multiphase optimization strategy (MOST) framework. In the preparation phase, we developed a conceptual model drawing on Transactive Goal Dynamics Theory, our own pilot work, and the published literature that includes four dyadic intervention components: dyadic action planning, joint feedback on goal progress, autonomy support training, and home environment modifications. In the proposed optimization phase, we plan to conduct an innovative and efficient factorial experiment to identify which combination of the four dyadic intervention components – when added to the core components of a standard behavioral weight loss program (BWL; e.g., weekly lessons, self-monitoring, feedback) – results in the greatest weight loss at 6 months (primary outcome). The 6-month intervention will be delivered to married and cohabitating couples (N=368 dyads) via a native smartphone app to enhance the reach of the intervention, minimize burden, and attract couples with more demographic and relationship diversity. Assessments will occur at 0, 3, and 6 months. Weight loss and theoretical mediators as framed by Transactive Goal Dynamics Theory (e.g., goal coordination) will be assessed along with hypothesized moderators (relationship and demographic variables). The set of novel dyadic intervention components that maximizes weight loss will be selected for inclusion in an optimized intervention package to be evaluated in a future randomized controlled trial. The proposed study is the first test of a fully mHealth weight loss intervention for married and cohabitating couples. Using the MOST design, it will advance both intervention and theory development by isolating active dyadic intervention components and their mechanisms of action.